• Front page
• Receive this content on your RSS reader

This Speakout has not been edited.

By Dr. Andrew Lieber

I want a chance to write an opinion piece. Let me have a chance to write an article explaining to everyone how the current health care system works.

Today I read the opinion piece, “Stripping down the price of health care.” I am a pediatrician in Denver, and I would love to elaborate on Mr. Schallert’s piece.

He used the analogy of Jiffy Lube submitting your claims to a third party insurance company. First, this does happen when you get into an auto accident. Your repairs are submitted via third party claims, and you never know what the real cost of repairs are. If an auto repair shop does their job right, they tell your insurance company what they need. Then they do it faster, cheaper, and pocket the extra money.

But, let us continue to extend this analogy to health care. Let’s say that you are the owner of Jiffy Lube, and you are not allowed to charge what you want for your services. Let’s say that you have to submit your charges to a third party. Let’s call that company United CarCare, or Pacifi-CAR, or perhaps the government funded Medi-CAR. And let’s say that for every oil change you did, they paid you a different price. Moreover, they will not tell you what they will pay you. They claim that they never received your bill, even though you submitted it electronically and they sent you an electronic receipt. Then they won’t pay you, because they claim you submitted it too late. OR, after 90 days, they pay you whatever they choose, usually less than what it costs you to pay for the oil you used. And you have no hope of disputing what they pay you.

Then, United CarCare arbitrarily reduces what they pay you every year. They tell you that the wiper blades you replaced should have been done at another appointment, and therefore, they do not have to reimburse you for the wiper blades. And well, the price of oil has gone up, but they feel that it has been factored into what they paid you.

Oh wait! It gets more fun! Because they never pay you in less than 90 days, you have to hire a fourth party. You pay them 7.5% of your collections, usually around $35,000 per year per doctor in your office (I mean per mechanic). And their sole purpose is to call United CarCare and say, “Why haven’t you paid our doctor yet?” (um, I mean Jiffy Lube).

United’s response is that their costs have risen dramatically, and it’s all your doctor’s (I mean Jiffy Lube’s) fault. It’s all his fault even though they just raised your insurance rates by 30%, and they raised your deductible by 30%. And, well, how can they pay their poor, desperate CEO the $1 billion bonus they just gave him in stock options (yes, you read that right — billion!). It must be the doctor’s fault!

Meanwhile, all of your clients are mad that their deductible has gone up, and they never pay you the money that they owe. You eat that money (usually in the $100,000 range) every year. Why? Because all of your clientelle think you’re a rich doctor (I mean Jiffy Lube owner). They think you’re rich even though you are still paying off the $150,000 of loans you took out to go to school and the $200,000 in loans you took out to start your business. They think you’re rich even though you eat $100,000 of bad debt every year. And it’s not tax deductible! The IRS considers it a virtual loss, not a real loss! Isn’t this fun!

I would be amazed if Mr. Schallert would give up nearly 20 years of his life and hundreds of thousands of his hard-earned dollars to do this job solely because you love children. Twenty years before you see any return on your investment. Then everyone tells you that the only solution is for you to make less. Everyone else in the field will make the same, including the CEO of United. But the government will now tell you how much you are allowed to earn. Or maybe Mr. Schallert thinks that everyone will want own a Jiffy Lube if they risk losing their house when the client’s car doesn’t start. Even if it’s not your fault.

Talk to all of the people in Canada who come across the border to get life-saving treatment when they need it. Talk to the poor patient in Toronto who is told that they cannot have that colon cancer surgery that would save their life now, but they can have it in 6 months when they are dead. Talk to the health ministers in France and Germany who are desperately trying to cut their budgets. Watch the riots in Paris when people find out that their benefits are being cut. Michael Moore made this seem too simplistic. Ask Mr. Moore to name all of the medical advances that have come out of other countries in the last 20 years. Oh wait, that was a researcher in America who just won the Nobel Prize for medicine.

There may be some benefits to goverment-run health care, but the answer is complex. In those countries where there is socialized medicine, the government pays for all costs for medical students. They do not have student loans. And people pay taxes that are extremely high. If the government did that for me, I would not have a problem. But they didn’t. And guess what, Mr. Schallert? You live in Republican-controlled Douglas County. Your neighbors are willing to bankrupt the state of Colorado to get their $75 TABOR refund. I want to be listening to that phone call you give your neighbors and your congressman explaining how they will pay $7,500 more per year in taxes to get health care. That will be pure entertainment.

The government needs to help the people who cannot help themselves. The poor and the working class who are underinsured need desperate help. But you cannot keep asking the medical community to foot the bill. We will all need to pay our fair share, and stop complaining! Stop blaming your doctor for this mess, it’s not his/her fault! I, and many other doctors, went into this work because we wanted to make a difference in people’s lives. In pediatrics, we truly love the work. We love children. But it is a very complex job. None of us like the business side of medicine.

Most physicians want to see a change. Yet I believe that Americans as a whole are not really willing to make the sacrifices that are necessary. As long as Americans think they deserve everything but don’t have to pay the taxes to get it, do not expect any resolution to this looming crisis.

Dr. Andrew Lieber is a resident of Denver.

READER COMMENTS

I should imagine that future MD curricula will need to include a very intensive accounting component.

PUT YOUR ATOMIC TIN FOIL HATS ON, HERE'S MORE THAN YOU EVER WANTED TO KNOW WHY MED COSTS ARE SKYROCKETING:

One way to see just how much the government is driving up costs is to compare the CPI and the PCED measures of medical care goods & services prices. The more comprehensive PCED (personal consumption expenditures deflator) includes government-financed health care costs, while the CPI covers only out-of-pocket costs (including those covered by private insurance) of urban consumers:
(1) The CPI rate was at a three-year high of 4.6% y/y in September, while the PCED rate was at an eight-month low of 2.8% in August.
(2) The services component of these two measures accounts for most of this divergence. The medical care services CPI rate jumped to 5.6% y/y in September, the highest since December 2002. The comparable PCED rate was 3.1% y/y in August, the lowest since last December.
(3) Within services, the problem is mostly in the hospitals price component. Based on the CPI, these costs rose 6.9% y/y in September, up from 5.9% in June, but below last September’s 7.5%. The rate was as high as 9.9% at the end of 2002. Based on the PCED, the yearly inflation rate was 2.9% in August, the lowest since March 2000.
(4) Since 1998, the average spreads between the CPI and PCED inflation rates for medical care goods & services, services, and hospitals were 94bps, 126bps, and 242bps, respectively.
(5) Since 1998, medical care goods and services prices are up 49.0% and 35.3% based on the CPI and PCED.
(6) Since 1998, medical services prices are up 54.0% and 35.3% based on the CPI and PCED.
(7) Since 1998, hospital prices are up 80.4% and 41.7% based on the CPI and PCED.

These comparisons all strongly suggest that as government spending on health care has increased to 40% of total such spending in the US from 30% in 1990 and 20% in 1970, the private sector has borne huge increases in health care costs. This is because the government, given its size and power in the industry, effectively controls the prices it pays. This forces providers to raise their prices to the private sector to remain profitable. Private health care insurance companies have responded by raising deductibles and copays. The physician’s services component of the CPI includes copays. It is up 35.2% since 1998, while the PCED component is up 20.1%.
---
Boot the government out of the current system, encourage choice and competition with folks spending their own money in their own best interest, and watch prices change for the better! Government is the problem, not the solution.

I should imagine that future MD curricula will need to include a very intensive accounting component.

Dr. Lieber, I somewhat agree with you on your analysis.I believe Dr.'s should be paid for their services.I always make sure my Dr. is paid and paid promptly. I can go onto my Insurances website and see when a claim was made ,how much the claim was for and what was paid to the Dr.I have had to call my insurance twice to get them to pay a bill that was incorrectly submitted by the Dr's billing office.

My Dr.'s have a contract with my insurance company. I can't do anything about what they get paid for services.I don't know how anyone gets away without paying deductables or co-pays.It has been my experience that they won't let you see a Dr. without paying your co-pay or deductible.

Now for the reality part. Many Dr's should not be practicing. There is no way to get the bad apples out of your profession.We are stuck often with inferior service and care.Where are the patients rights to get good service.We can't get a refund for poor service.
My mother died because of the poor service she recieved.How come Dr's think they can keep you waiting for 1/2 hour passed your appt. give you 5 mins. of their time and expect my insurance company to pay you $150 for a visit?
Are not Dr's also responsible for the healthcare system chaos we have today?

Dr.'s also have some responsibility in this mess.There is no way to weed out the bad ones because you protect each other.You put bad Dr.'s ahead of the good of the patients.No matter how many bad Dr.'s there are.

Patient's should have some recourse against shoddy treatment from Dr.'s besides having our insurance pay for them.

Clean up your own profession and then maybe people wouldn't mind paying you.Until then if you and other Dr.'s continue to protect your own no matter how bad they are,then you deserve what you get.

A good socialist asks not what they can do for their country, but asks what you can do for them. Thank you Dr. Lieber for your excellent letter. It is probably a little too adult for those who wish to enslave you to their service.
The poet Robert Frost said "Men fear freedom because freedom means responsibility." The irresponsible in life look to those who have borne personal responsibility to bail them out, again and again.
I know of 2 doctors that are leaving the profession, due to the very factors stated by Dr. Lieber. To acheive the level of education to become a doctor, involves discipline, self-sacrifice and delayed gratification.
Socialism has never produced dedicated and motivated individuals. It produces entitlement. While people scream about the costs of healthcare, that very system has been caring for the needy, irresponsible, and every illegal alien who walks through the door. They have borne the costs and some are going bankrupt.

Monopolies are hostile to consumers, and health monopolies run by the government--or anyone else--are no different. Monopolies always generate higher prices and less service. The best that such a system could provide is the rationing of it resources.

The best health system will provide choices and competition and permit each participant to "shop" the system and spend their own money in their own best interest. This guarantees the best possible service at the lowest possible price.

The welfare junies, who are not accountable or responsible for themselves, will continue to drag society to the bottom of the barrel. We owe these people nothing--and neither do our children's children. They can rely on the same folks who run the post office, maintain our bridges, run congress and make the country's energy policies for their next kidney transplant. I for one am not interested in such a welfare/entitlement system. The Cukoo's Nest is no place to seek your your next heartbeat.

Finally, if we get the junkies healthcare system in the USA, then where will all those poor Canadians go for their healthcare?

POST A COMMENT

• Mostly wrong on warming
• Doctors caught in the middle in health-care crisis
• Follow the money on the upcoming bond/tax increase elections
• Morris, Means don’t represent Indians
• Does al-Qaida even really exist?
• Paying for others’ health care
• A tale of two peoples
• Government education supporters cannot pick and choose how much government they get